Health Care Reform: There's an Elephant in the Room

Every day on my Metro North commuter train to Grand Central, a group of friends (strangers to me) travel together. They always sit in the same "five-seater," talking and laughing among themselves. I couldn't tell you what they talk about most mornings, although certainly when one of them had twins, that was an exciting topic of conversation for a few days.

This morning, though, was different. Just as I finished reading David Leonhardt's New York Times piece, Real Challenge to Health Bill: Selling Reform, I picked up on a heated tone coming from the group of five. They were discussing health care reform and their very different views on what needed to happen. I couldn't hear the specifics, but it was clear that this issue was a deeply personal one and that they each had strong and differing opinions about issues from the costs of developing drugs to incentives for excellent medical care to debate about whether universal health care would mean an overall decline in quality.

The conversation lasted less than 10 minutes, but it showed me that Leonhardt is right on about the challenge facing President Obama tonight when he talks to the nation about the first six months of his term and highlights what's to come. Obviously health care reform is at the top of that list. Leonhardt asserts that Barack Obama's meteoric rise to the presidency came "in large measure because of his ability to explain complex issues and then to make a persuasive argument." He observes that our health care system is one of the most complex and least understood systems in this country, and that the interest of lobbyists has driven its evolution.

Based on our experience at The Michael J. Fox Foundation, I'd add that the entire medical research enterprise -- from basic science through translational research, clinical trials and care delivery -- suffers from an extreme lack of strategic oversight. In our opinion, that -- combined with the vested and disparate interests of stakeholders along the way -- is why we have the mess we have today.

I wish I were smart enough to know the answer, and I don't pretend to be. But I do know it's critical that we all understand the problem. It is not acceptable that U.S. health care costs are so high -- according to Leonhardt, roughly $15,000 per household this year, about twice what they were on an inflation-adjusted basis two decades ago and about $6,500 more than in other rich countries on average -- and that the overall quality is so low. While debate can get hung up on one aspect of the plan or another, we all have to realize that reform is imperative. The question is not: Should we take on health care reform? Rather: What is the root of the problem? What dimensions of reform are most critical? Where should reform begin?

In the last year and a half, our country has had to pull its head out of the sand on numerous issues as the economy has tanked and recession has set in. Our days of ignoring problems and thinking they will go away are finished. The problem our Foundation is facing head on has to do, in part, with the inefficiencies of the existing medical research enterprise, one piece of the overall health care puzzle. As we've learned more about the systemic problems that impede a fast track toward a cure for PD, we've realized that our strategy must, in large part, be directed toward addressing those challenges. And we've learned that clear articulating of what's broken in the medical research system, and how that drives our business model, is critical to building support for our efforts. It's far from a simple thing to communicate. But we find that when people understand the true nature of the problem, they often become very enthusiastic about our Foundation's strategy: to do everything we can to streamline a labyrinthine system, tackle roadblocks, bridge gaps, and get people and institutions talking to each other more effectively across the board.

I sincerely hope President Obama can tonight articulate in an accessible and understandable way the nature of the broader health care problem our country faces, of which medical research is certainly a part. My greatest hope is that before we develop the specific elements of a health care reform plan, we clearly articulate the nature of the entire problem in a way that all Americans can understand. Only then can we strategically prioritize the areas where reform is needed in the short, medium, and long-term. I believe this process is necessary if there is to be truly widespread acceptance of reform proposals that are being and will be considered. Otherwise, health care reform 2009 will be much more like the parable of the blind men and the elephant than it should be if we are to develop true solutions to the systemic problems we face.

Comments

[Allison Bland]

Thanks for pointing out that medical research needs to be emphasized for the long-term outlook for health care in the U.S. I think we'll find that the benefits of research will turn up soon than we think, especially with the emphasis on health IT and comparative effectiveness research. Elected officials need to know that we think medical research is important, and we'd like to have them on the record on these issues over at http://www.yourcongressyourhealth.org.

[indigogo]

"Helpless" is the last word I would use to describe the Michael J Fox Foundation. Instead, their strategic and innovative thinking about Parkinson's disease research has not only helped streamline and integrate the scientific process, but has also helped everyone involved "understand the true nature of the problem," - that Parkinson's is much more complex than the disease that has been researched and treated to date. Our health care system is much the same - a complex system embedded and entwined with other complex systems. I hope someone is responsible for looking at the whole thing. If the Obama administration needs help, MJFF provides a great model for looking at old systems with new eyes.

[lastyellowdogintx]

I keep hearing about "choice" in the healthcare debate.
I have never had a "choice". My various companies have
all made the "choice" for me through the last 40 years.
That "choice" has always been what's better for them
not what's better for me. All the "true capitalists" are
now telling me that a public option would be bad for me
even when they admit it would be cheaper. Seems to me
it would finally give me a "choice".

[TJCole]

What this debate and issue has shown us is that our Congress and Senate are Corrupted..!

We must end Corporate "Personhood" to Reform anything...!

http://www.commondreams.org/view/2009/07/06-0

[tompoe]

The Foundation might want to consider a little experiment. Take a research grant program that has already been "completed". Redo it, using a nonproprietary automated clinical data collection system for the human clinical trials phases. This can be done in the lab. Work with the Center for Drug Evaluation and Research from the beginning (use the original language of the Accelerated Approval Act of 1992). You will quickly realize that you could have saved over 70% of R&D costs. In other words, you dolled out huge sums of money needlessly.

The simple requirement that all human clinical trials be conducted and managed using a nonproprietary automated clinical trials data collection system dramatically impacts the present drug approval process. Too many changes to detail here. Your foundation needs to question why this requirement is hated so much by Big Pharma. Want to help your patients? Ask the question, and stop acting like you're helpless.

[Katie Hood - Huffpost Blogger]

In terms of seeming to act helpless – certainly wasn’t my intent! If anything, we spend a lot of time doing the exact opposite of throwing up our hands and looking to others for solutions. But I don’t write back about that. I write because I am not familiar with the nonproprietary automated clinical data collection system you refer to although I see you’ve brought up this topic on other blogs, including one of mine from last year. I would love to know more about the system. I know that there are efforts – including one by C-Path, to aggregate control data from clinical trials (which we think would be a great step forward) but I think you’re talking about something different.